RESEARCH DEVELOPMENT OF DIAGNOSIS AND TREATMENT OF MENISCAL ROOT TEARS_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIUJun , SUNYunbo , WANGLei , ZHANGDongliang , ZHANGYu ,  SUNZhenhui

Department of Orthopedics, People's Hospital of Tianjin, Tianjin, 300000, P. R. China;

Corresponding author：

SUNZhenhui, Email: sunzhenhui123@gmail.com

Keywords：

Meniscal root tear; Diagnosis; Repair and reconstruction

DOI：

10.7507/1002-1892.20140280

Video：

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Objective To analyze the causes of meniscal root tears (MRTs), and to review the progress in its diagnosis and therapy. Methods The published literature about MRTs was extensively reviewed and summarized. Results MRTs can be divided into acute traumatic injuries and chronic degenerative injuries; MRI examination is an effective way to diagnose according to meniscal extrusion, ghost sign, and meniscal root linear defects. Conservative treatments are mainly performed for chronic MRTs; partial meniscectomy can obtain predictable improvement in symptoms. Acute MRTs can be treated by arthroscopic meniscus repair and reconstruction which can effectively restore meniscal root anatomy and function, and knee joint degeneration can be postponed. Conclusion MRTs diagnosis relies on MRI, appropriate treatment plan should be made based on the specific circumstances of the patient after accurate diagnosis. Usually the satisfied short-term clinical results can be obtained, while the long-term results need more clinical evaluation.

Citation： LIUJun, SUNYunbo, WANGLei, ZHANGDongliang, ZHANGYu, SUNZhenhui. RESEARCH DEVELOPMENT OF DIAGNOSIS AND TREATMENT OF MENISCAL ROOT TEARS. Chinese Journal of Reparative and Reconstructive Surgery, 2014, 28(10): 1298-1302. doi: 10.7507/1002-1892.20140280 Copy

1.	Greis PE, Bardana DD, Holmstrom MC, et al.Meniscal injury:I.Basic science and evaluation.J Am Acad Orthop Surg, 2002, 10(3):168-176.
2.	Koenig JH, Ranawat AS, Umans HR, et al.Meniscal root tears:diagnosis and treatment.Arthroscopy, 2009, 25(9):1025-1032.
3.	Kopf S, Colvin AC, Muriuki M, et al.Meniscal root suturing techniques:implications for root fixation.Am J Sports Med, 2011, 39(10):2141-2146.
4.	Bhatia S, Laprade CM, Ellman MB, et al.Meniscal Root Tears:Significance, Diagnosis, and Treatment.Am J Sports Med, 2014.[Epub ahead of print].
5.	Mariani PP, Iannella G, Cerullo G, et al.Avulsion of both posterior meniscal roots associated with acute rupture of the anterior cruciate ligament.J Orthop Traumatol, 2014.[Epub ahead of print].
6.	Papalia R, Vasta S, Franceschi F, et al.Meniscal root tears:from basic science to ultimate surgery.Br Med Bull, 2013, 106:91-115.
7.	Hwang BY, Kim SJ, Lee SW, et al.Risk factors for medial meniscus posterior root tear.Am J Sports Med, 2012, 40(7):1606-1610.
8.	Matava MJ, Muller MS, Clinton CM, et al.Complications of anterior cruciate ligament reconstruction.Instr Course Lect, 2009, 58:355-375.
9.	Padalecki JR, Jansson KS, Smith SD, et al.Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site:in situ pull-out repair restores derangement of joint mechanics.Am J Sports Med, 2014, 42(3):699-707.
10.	Allaire R, Muriuki M, Gilbertson L, et al.Biomechanical consequences of a tear of the posterior root of the medial meniscus.Similar to total meniscectomy.J Bone Joint Surg (Am), 2008, 90(9):1922-1931.
11.	Marzo JM, Gurske-DePerio J.Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications.Am J Sports Med, 2009, 37(1):124-129.
12.	Hein CN, Deperio JG, Ehrensberger MT, et al.Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement.Knee, 2011, 18(3):189-192.
13.	Seo JH, Li G, Shetty GM, et al.Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique:a biomechanical study using porcine knees.Arthroscopy, 2009, 25(11):1281-1287.
14.	Laprade CM, James EW, Engebretsen L, et al.Anterior medial meniscal root avulsions due to malposition of the tibial tunnel during anterior cruciate ligament reconstruction:two case reports.Knee Surg Sports Traumatol Arthrosc, 2014, 22(5):1119-1123.
15.	Watson JN, Wilson KJ, LaPrade CM, et al.Iatrogenic injury of the anterior meniscal root attachments following anterior cruciate ligament reconstruction tunnel reaming.Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].
16.	Ellman MB, James EW, Laprade CM, et al.Anterior meniscus root avulsion following intramedullary nailing for a tibial shaft fracture.Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].
17.	Costa CR, Morrison WB, Carrino JA.Medial meniscus extrusion on knee MRI:is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol, 2004, 183(1):17-23.
18.	De Smet AA, Blankenbaker DG, Kijowski R, et al.MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard.AJR Am J Roentgenol, 2009, 192(2):480-486.
19.	Berlet GC, Fowler PJ.The anterior horn of the medical meniscus.An anatomic study of its insertion.Am J Sports Med, 1998, 26(4):540-543.
20.	Feucht MJ, Minzlaff P, Saier T, et al.Avulsion of the anterior medial meniscus root:case report and surgical technique.Knee Surg Sports Traumatol Arthrosc, 2013.[Epub ahead of print].
21.	Navarro-Holgado P, Cuevas-Pérez A, Aguayo-Galeote MA, et al.Anterior medial meniscus detachment and anterior cruciate ligament tear.Knee Surg Sports Traumatol Arthrosc, 2007, 15(5):587-590.
22.	Choi SH, Bae S, Ji SK, et al.The MRI findings of meniscal root tear of the medial meniscus:emphasis on coronal, sagittal and axial images.Knee Surg Sports Traumatol Arthrosc, 2012, 20(10):2098-2103.
23.	Nguyen JC, De Smet AA, Graf BK, et al.MR imaging-based diagnosis and classification of meniscal tears.Radiographics, 2014, 34(4):981-999.
24.	Lee SY, Jee WH, Kim JM.Radial tear of the medial meniscal root:reliability and accuracy of MRI for diagnosis.AJR Am J Roentgenol, 2008, 191(1):81-85.
25.	Ohishi T, Suzuki D, Yamamoto K, et al.Medial extrusion of the posterior segment of medial meniscus is a sensitive sign for posterior horn tears.Knee, 2014, 21(1):112-118.
26.	Lerer DB, Umans HR, Hu MX, et al.The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion.Skeletal Radiol, 2004, 33(10):569-574.
27.	Choi CJ, Choi YJ, Lee JJ, et al.Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear.Arthroscopy, 2010, 26(12):1602-1606.
28.	Kijowski R, Davis KW, Blankenbaker DG, et al.Evaluation of the menisci of the knee joint using three-dimensional isotropic resolution fast spin-echo imaging:diagnostic performance in 250 patients with surgical correlation.Skeletal Radiol, 2012, 41(2):169-178.
29.	Pagnani MJ, Cooper DE, Warren RF.Extrusion of the medial meniscus.Arthroscopy, 1991, 7(3):297-300.
30.	Longo UG, Campi S, Romeo G, et al.Biological strategies to enhance healing of the avascular area of the meniscus.Stem Cells Int, 2012, 2012:528359.
31.	Shelbourne KD, Roberson TA, Gray T.Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction.Am J Sports Med, 2011, 39(7):1439-1443.
32.	Kim SB, Ha JK, Lee SW, et al.Medial meniscus root tear refixation:comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy.Arthroscopy, 2011, 27(3):346-354.
33.	Raustol OA, Poelstra KA, Chhabra A, et al.The meniscal ossicle revisited:etiology and an arthroscopic technique for treatment.Arthroscopy, 2006, 22(6):687.e1-3.
34.	Kim YM, Rhee KJ, Lee JK, et al.Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn.Arthroscopy, 2006, 22(7):795.e1-4.
35.	Petersen W, Zantop T.Avulsion injury to the posterior horn of the lateral meniscus.Technique for arthroscopic refixation.Unfallchirurg, 2006, 109(11):984-987.
36.	Stärke C, Kopf S, Gröbel KH, et al.The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension:a biomechanical study.Arthroscopy, 2010, 26(3):358-365.
37.	Engelsohn E, Umans H, Difelice GS.Marginal fractures of the medial tibial plateau:possible association with medial meniscal root tear.Skeletal Radiol, 2007, 36(1):73-76.
38.	Choi NH, Son KM, Victoroff BN.Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus:a technical note.Knee Surg Sports Traumatol Arthrosc, 2008, 16(9):891-893.
39.	Ahn JH, Lee YS, Chang JY, et al.Arthroscopic all inside repair of the lateral meniscus root tear.Knee, 2009, 16(1):77-80.
40.	Griffith CJ, LaPrade RF, Fritts HM, et al.Posterior root avulsion fracture of the medial meniscus in an adolescent female patient with surgical reattachment.Am J Sports Med, 2008, 36(4):789-792.

1. Greis PE, Bardana DD, Holmstrom MC, et al.Meniscal injury:I.Basic science and evaluation.J Am Acad Orthop Surg, 2002, 10(3):168-176.
2. Koenig JH, Ranawat AS, Umans HR, et al.Meniscal root tears:diagnosis and treatment.Arthroscopy, 2009, 25(9):1025-1032.
3. Kopf S, Colvin AC, Muriuki M, et al.Meniscal root suturing techniques:implications for root fixation.Am J Sports Med, 2011, 39(10):2141-2146.
4. Bhatia S, Laprade CM, Ellman MB, et al.Meniscal Root Tears:Significance, Diagnosis, and Treatment.Am J Sports Med, 2014.[Epub ahead of print].
5. Mariani PP, Iannella G, Cerullo G, et al.Avulsion of both posterior meniscal roots associated with acute rupture of the anterior cruciate ligament.J Orthop Traumatol, 2014.[Epub ahead of print].
6. Papalia R, Vasta S, Franceschi F, et al.Meniscal root tears:from basic science to ultimate surgery.Br Med Bull, 2013, 106:91-115.
7. Hwang BY, Kim SJ, Lee SW, et al.Risk factors for medial meniscus posterior root tear.Am J Sports Med, 2012, 40(7):1606-1610.
8. Matava MJ, Muller MS, Clinton CM, et al.Complications of anterior cruciate ligament reconstruction.Instr Course Lect, 2009, 58:355-375.
9. Padalecki JR, Jansson KS, Smith SD, et al.Biomechanical consequences of a complete radial tear adjacent to the medial meniscus posterior root attachment site:in situ pull-out repair restores derangement of joint mechanics.Am J Sports Med, 2014, 42(3):699-707.
10. Allaire R, Muriuki M, Gilbertson L, et al.Biomechanical consequences of a tear of the posterior root of the medial meniscus.Similar to total meniscectomy.J Bone Joint Surg (Am), 2008, 90(9):1922-1931.
11. Marzo JM, Gurske-DePerio J.Effects of medial meniscus posterior horn avulsion and repair on tibiofemoral contact area and peak contact pressure with clinical implications.Am J Sports Med, 2009, 37(1):124-129.
12. Hein CN, Deperio JG, Ehrensberger MT, et al.Effects of medial meniscal posterior horn avulsion and repair on meniscal displacement.Knee, 2011, 18(3):189-192.
13. Seo JH, Li G, Shetty GM, et al.Effect of repair of radial tears at the root of the posterior horn of the medial meniscus with the pullout suture technique:a biomechanical study using porcine knees.Arthroscopy, 2009, 25(11):1281-1287.
14. Laprade CM, James EW, Engebretsen L, et al.Anterior medial meniscal root avulsions due to malposition of the tibial tunnel during anterior cruciate ligament reconstruction:two case reports.Knee Surg Sports Traumatol Arthrosc, 2014, 22(5):1119-1123.
15. Watson JN, Wilson KJ, LaPrade CM, et al.Iatrogenic injury of the anterior meniscal root attachments following anterior cruciate ligament reconstruction tunnel reaming.Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].
16. Ellman MB, James EW, Laprade CM, et al.Anterior meniscus root avulsion following intramedullary nailing for a tibial shaft fracture.Knee Surg Sports Traumatol Arthrosc, 2014.[Epub ahead of print].
17. Costa CR, Morrison WB, Carrino JA.Medial meniscus extrusion on knee MRI:is extent associated with severity of degeneration or type of tear? AJR Am J Roentgenol, 2004, 183(1):17-23.
18. De Smet AA, Blankenbaker DG, Kijowski R, et al.MR diagnosis of posterior root tears of the lateral meniscus using arthroscopy as the reference standard.AJR Am J Roentgenol, 2009, 192(2):480-486.
19. Berlet GC, Fowler PJ.The anterior horn of the medical meniscus.An anatomic study of its insertion.Am J Sports Med, 1998, 26(4):540-543.
20. Feucht MJ, Minzlaff P, Saier T, et al.Avulsion of the anterior medial meniscus root:case report and surgical technique.Knee Surg Sports Traumatol Arthrosc, 2013.[Epub ahead of print].
21. Navarro-Holgado P, Cuevas-Pérez A, Aguayo-Galeote MA, et al.Anterior medial meniscus detachment and anterior cruciate ligament tear.Knee Surg Sports Traumatol Arthrosc, 2007, 15(5):587-590.
22. Choi SH, Bae S, Ji SK, et al.The MRI findings of meniscal root tear of the medial meniscus:emphasis on coronal, sagittal and axial images.Knee Surg Sports Traumatol Arthrosc, 2012, 20(10):2098-2103.
23. Nguyen JC, De Smet AA, Graf BK, et al.MR imaging-based diagnosis and classification of meniscal tears.Radiographics, 2014, 34(4):981-999.
24. Lee SY, Jee WH, Kim JM.Radial tear of the medial meniscal root:reliability and accuracy of MRI for diagnosis.AJR Am J Roentgenol, 2008, 191(1):81-85.
25. Ohishi T, Suzuki D, Yamamoto K, et al.Medial extrusion of the posterior segment of medial meniscus is a sensitive sign for posterior horn tears.Knee, 2014, 21(1):112-118.
26. Lerer DB, Umans HR, Hu MX, et al.The role of meniscal root pathology and radial meniscal tear in medial meniscal extrusion.Skeletal Radiol, 2004, 33(10):569-574.
27. Choi CJ, Choi YJ, Lee JJ, et al.Magnetic resonance imaging evidence of meniscal extrusion in medial meniscus posterior root tear.Arthroscopy, 2010, 26(12):1602-1606.
28. Kijowski R, Davis KW, Blankenbaker DG, et al.Evaluation of the menisci of the knee joint using three-dimensional isotropic resolution fast spin-echo imaging:diagnostic performance in 250 patients with surgical correlation.Skeletal Radiol, 2012, 41(2):169-178.
29. Pagnani MJ, Cooper DE, Warren RF.Extrusion of the medial meniscus.Arthroscopy, 1991, 7(3):297-300.
30. Longo UG, Campi S, Romeo G, et al.Biological strategies to enhance healing of the avascular area of the meniscus.Stem Cells Int, 2012, 2012:528359.
31. Shelbourne KD, Roberson TA, Gray T.Long-term evaluation of posterior lateral meniscus root tears left in situ at the time of anterior cruciate ligament reconstruction.Am J Sports Med, 2011, 39(7):1439-1443.
32. Kim SB, Ha JK, Lee SW, et al.Medial meniscus root tear refixation:comparison of clinical, radiologic, and arthroscopic findings with medial meniscectomy.Arthroscopy, 2011, 27(3):346-354.
33. Raustol OA, Poelstra KA, Chhabra A, et al.The meniscal ossicle revisited:etiology and an arthroscopic technique for treatment.Arthroscopy, 2006, 22(6):687.e1-3.
34. Kim YM, Rhee KJ, Lee JK, et al.Arthroscopic pullout repair of a complete radial tear of the tibial attachment site of the medial meniscus posterior horn.Arthroscopy, 2006, 22(7):795.e1-4.
35. Petersen W, Zantop T.Avulsion injury to the posterior horn of the lateral meniscus.Technique for arthroscopic refixation.Unfallchirurg, 2006, 109(11):984-987.
36. Stärke C, Kopf S, Gröbel KH, et al.The effect of a nonanatomic repair of the meniscal horn attachment on meniscal tension:a biomechanical study.Arthroscopy, 2010, 26(3):358-365.
37. Engelsohn E, Umans H, Difelice GS.Marginal fractures of the medial tibial plateau:possible association with medial meniscal root tear.Skeletal Radiol, 2007, 36(1):73-76.
38. Choi NH, Son KM, Victoroff BN.Arthroscopic all-inside repair for a tear of posterior root of the medial meniscus:a technical note.Knee Surg Sports Traumatol Arthrosc, 2008, 16(9):891-893.
39. Ahn JH, Lee YS, Chang JY, et al.Arthroscopic all inside repair of the lateral meniscus root tear.Knee, 2009, 16(1):77-80.
40. Griffith CJ, LaPrade RF, Fritts HM, et al.Posterior root avulsion fracture of the medial meniscus in an adolescent female patient with surgical reattachment.Am J Sports Med, 2008, 36(4):789-792.

Chinese Journal of Reparative and Reconstructive Surgery

RESEARCH DEVELOPMENT OF DIAGNOSIS AND TREATMENT OF MENISCAL ROOT TEARS

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